In actuality, we really don't know what causes cellulite. One theory suggests cellulite arises from swelling within localized fatty areas. This can be accentuated by increases in lymphatic pressure or venous blood pressure. For some, excess fat, loose skin, or a combination of the two additionally contribute to the problem. Stress, trauma, diet, medications, and pregnancy have also been listed as possible contributing factors.
In my mind, the two main causes of cellulite are 1) abnormal skin related (bulges) due to both fat and swelling which is accentuated by adjacent tight supportive connective tissue of the skin (think button on a pillow) or 2) loose skin causing a traction on this connective tissue. For some patients, both factors come into play.
What treatment options are there?
After a thorough review of the literature on the topic I can conclusively say that some of the treatment options help a little, some of the time. Not very authoritative, I know, but that is the problem with cellulite. If there were really a method of treatment that was very effective there would not be so many options out there, would there?
Mesotherapy - (Lipodissolve is one version) - Highly advertised and hyped. Basically the injection of a nonstandardized mixture of chemicals intended to dissolve fat painlessly without surgery. Not generally supported by plastic surgeons and in my opinion a complete waste of money. Unbiased, comparative studies reveal no measurable effect (Plastic and Reconstructive Surgery, April 2008). I have actually seen a few patients who claim that this increased fat. I have never used this and at this point have no interest.
Cellulite creams - I have never seen a study or even anecdotal evidence that showed any improvement, I have seen studies that show no improvement (Plastic and Reconstructive Surgery, Sept 1999).
Body wraps - see creams
Endermologie - An external machine is used to roll and suck the skin which claims to reduce the appearance of cellulite.
UltraShape - Not FDA approved. Non-thermal ultrasound energy to break up the fat which is reabsorbed by the body. Promising in theory, needs the benefit of more time and research to know for sure. My only concern is where does it all go. The coronary arteries?
Velasmooth - A combination of RF and light energy applied externally to break up fat cells. Again, promising but needs more time and where does the fat go?
Velashape - basically Endermologie plus Velasmooth
Tumescent Liposuction - This is what I use for body contouring. Actually, I use a version of this, power assisted liposuction because it is a little quicker, easier and gentler on the patient. This does a fairly lousy job of treating cellulite by itself and I warn patients to this effect. With release of the depressions with a V shaped cannula and a little fat grafting this can be improved somewhat more. I would estimate about a 50% improvement.
Laser Liposuction (SmartLipo) - Highly advertised and hyped. Burn the tissue with a laser prior to removing it with liposuction (or leave it to be reabsorbed by the body). To me this is good as a marketing tool because who wouldn't want something "smart". Studies have failed to show any improvement (Plastic and Reconstructive Surgery, Sept 2006). Most surgeons (or non surgeons) using this technology are not plastic surgeons at this point. The danger is that a patient can focus on the technology rather than the experience and artistry of the surgeon which is vastly more important.
Ultrasound liposuction (Vaser liposuction) - In my opinion similar to laser lipo
It is easy to see why there is so much confusion about the treatment of cellulite. First, no one, and I mean no one really knows all of the causes for cellulite. Second, proponents of each method of treatment will try to sell their own technique in favor of others. The truth is, there is little scientific support for any of these methods for the treatment of cellulite. Even in the best cases the benefit is minor.
It would be great for patients and surgeons alike if one of these treatments or something on the horizon could treat cellulite consistently and effectively. In the meantime, I won't buy the hype of current methods or experiment on my patients with new technology until it is proven. For fatty bulges liposuction does very well but for cellulite don't expect too much.
